MEDICARE: MRS. KIM D PHAM R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP033704L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518317908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIM D PHAM R.PH.

Provider Business Mailing Address
First Line	:	140 GARRETT RD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3106
Country	:	US
Telephone Number	:	610-352-2477
Fax Number	:	610-352-3911

Provider Business Practice Location Address
First Line	:	140 GARRETT RD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3106
Country	:	US
Telephone Number	:	610-352-2477
Fax Number	:	610-352-3911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	01/11/2022

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